Monitored Anesthesia Care (MAC)

Question 1

difference between MAC & general anesthesia

Answer 1

MAC - patient can maintain own airway with reflexes

general anesthesia- patient is unresponsive and unable to protect own airway

Question 2

4 levels of continuum of sedation depth

Answer 2

1. minimal sedation (Anxiolysis)
2. moderate sedation (Conscious sedation)
3. Deep sedation
4. General anesthesia

Question 3

To perform MAC, considerations are:

Answer 3

1. pt must be able to cooperate
2. pt must be able to remain motionless
3. pt must adhere to pre-op NPO guidelines

Question 4

Loss of ____ reflex indicates loss of ____

Answer 4

eyelash, protective airway reflexes

Question 5

Required MAC monitors

Answer 5

• BP
• ETCO2
• EKG
• Pulse Ox
• assessment of ventilation adequacy
• presence of qualified anesthesia provider

Question 6

Additional MAC monitors (4)

Answer 6

• precordial stethoscope
• temperature monitoring
• capnography
• consciousness monitor (BIS)

Question 7

oxygenation devices in MAC

Answer 7

nasal cannula
face mask
oral airway
nasal airway
chin lift or jaw thrust

Question 8

assessment of oxygenation/ventilation

Answer 8

• chest excursion
• skin color
• nasal/oral airway movement
• condensation in face mask

Question 9

Versed administered for

Answer 9

anxiolysis & amnesia

Question 10

Fentanyl or opioid used for

Answer 10

analgesia

Question 11

Propofol used in MAC for

Answer 11

sleep

Question 12

Local anesthetics in MAC used for

Answer 12

infiltration / field block

Question 13

medication dosages highly variable due to:

Answer 13

1. surgical stimulus
2. patient medical history
3. surgeon experience

Question 14

Versed synergistic with __

Answer 14

opioids

Question 15

Opioids used in MAC

Answer 15

alfentanil
fentanyl
morphine
remifentanil

Question 16

opioids may cause
1 resp
1 cv

Answer 16

respiratory depression

bradycardia

Question 17

3 targets of opioids in pain management

Answer 17

1. inadequate local anesthetic
2. uncomfortable position
3. tourniquet use

Question 18

superior drug for MAC cases ___

Answer 18

propofol

Question 19

propofol good for ____ in MAC

Answer 19

sedative-hypnotic properties

Question 20

positives of propofol

Answer 20

• short acting
• rapid onset
• short duration
• decreased N/V

Question 21

Propofol bolus technique during MAC

Answer 21

10-20mg PRN

Question 22

propofol continuous infusion during MAC

Answer 22

25-75mcg/kg/min

Question 23

additional medications used during MAC (4)

Answer 23

• ketorolac
• ketamine
• clonidine
• dexmedetomodine

Question 24

positioning during MAC

Answer 24

for level of sedation, consider:

• ease of airway manipulation
• ability to access & control airway

Question 25

Plan B during MAC

Answer 25

ALWAYS general anesthesia

Question 26

Why does MAC fail (4)

Answer 26

1. inadequate LA 2. painful position 3. uncooperative patient 4. paradoxical effects from sedation

Question 27

INAPPROPRIATE MAC cases

Answer 27

- muscle relaxation required - difficult airway with limited access - Peds - psychiatric disorders - uncooperative patients - pt that refuses MAC

Question 28

during MAC, always prepare for:

Answer 28

*advanced airway management / general anesthesia

Question 29

have ___ at bedside

Answer 29

equipment for general anesthesia & airway adjuncts - medications - suction - oral/nasal airways, LMA, ETT, laryngoscope, blades/handles

Question 30

___ is the best monitor

Answer 30

vigilance

Question 31

greatest danger during MAC

Answer 31

lack of vigilance

Question 32

standards of care during MAC =

Answer 32

standards of care during general anesthesia

Question 33

4 effects of medications we want during MAC

Answer 33

1. anxiolytic 2. hypnotic 3. analgesic 4. amnestic

Question 34

PRIMARY objective during MAC

Answer 34

provide patient safety & comfort during procedures for which general anesthesia is not used

Question 35

MAC invokes ___ than general & provides ___ than general

Answer 35

less physiological disturbances more rapid recovery

Question 36

in CONSCIOUS SEDATION, pt maintains (2)

Answer 36

1. adequate cardiorespiratory function | 2. ability to purposefully respond with verbal/tactile stimulation

Question 37

MAC anesthesia ____ than conscious sedation

Answer 37

- potential for deeper sedation | - loss of protective reflexes or consciousness likely

Question 38

*MOST common cause of brain injury during MAC

Answer 38

**inadequate ventilation

Question 39

__ may quickly change depth of MAC

Answer 39

interpatient response variability to drugs

Question 40

MAC helps to (2)

Answer 40

- relieve anxiety & apprehension | - prevent recall of unpleasant perioperative events

Question 41

Minimal Sedation 1. responsiveness 2. airway patency 3. spontaneous ventilation 4. cardiovascular function

Answer 41

"anxiolysis" 1. normal response to verbal stimulation 2. unaffected 3. unaffected 4. unaffected

Question 42

Moderate Sedation 1. responsiveness 2. airway patency 3. spontaneous ventilation 4. cardiovascular function

Answer 42

"conscious sedation" 1. purposeful response to verbal or tactile stimulation 2. no intervention required 3. adequate 4. usually maintained

Question 43

Deep Sedation 1. responsiveness 2. airway patency 3. spontaneous ventilation 4. cardiovascular function

Answer 43

1. purposeful response following repeated or painful stimulation 2. intervention may be required 3. may be inadequate 4. usually maintained

Question 44

General Anesthesia 1. responsiveness 2. airway patency 3. spontaneous ventilation 4. cardiovascular function

Answer 44

1. unarousable, even with painful stimulus 2. intervention often required 3. frequently inadequate 4. may be impaired